Effectiveness of Oral Nutritional Supplements on Older People with Anorexia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Nutrition plays an important role in maintaining the overall health of older people. Inadequate intake may lead to impaired body function, higher morbidity, and mortality. Oral nutritional supplements (ONS) showed positive effect on the nutritional status of the elderly; however, systematic evidence is currently lacking on the effect of ONS on the elderly with anorexia. Aims: The current systematic review and meta-analysis included randomized controlled trial (RCT) articles to investigate the effectiveness of ONS on the main aspects of anorexia of aging (AA). Methods: By using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, researchers independently searched PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and other gray literature resources for publications that met the inclusion criteria by October 2020. The Cochrane Risk of Bias Tools were used for quality assessment. The inverse-variance method was used for the fixed model (FM) while the DerSimonian–Laird method was used for the random model (RM). Respective 95% confidence intervals (95% CIs), mean difference (MD) or standardized mean difference (SMD) was used for indices in terms of effect size (ES). Results: 2497 records were found through the systematic search, while 17 RCTs (n = 1204) were included, with a mean age of 81.9 years (range: 74–87 years). Supplementation occurred in the morning, mid-day, and evening, while the times varied from one to three times a day. The results of meta-analysis showed that, generally, ONS had a positive effect on the overall appetite, MD = 0.18, 95% CI (0.03, 0.33), p = 0.02, and consumption, MD = 1.43, 95% CI (0.01, 2.86), p = 0.05; but not significant in terms of other aspects of appetite: hunger, p = 0.73; fullness, p = 0.60; desire to eat, p = 0.80; preoccupation, p = 0.15. Additionally, it showed an increase in the overall energy intake, SMD = 0.46, 95% CI (0.29, 0.63), p < 0.001, in protein intake, SMD = 0.59, 95% CI (0.16, 1.02), p = 0.007, and in fat intake, MD = 3.47, 95% CI (1.98, 4.97), p < 0.001, while no positive effect was found on carbohydrates intake, p = 0.06. Significance differences were also found in the body weight, SMD = 0.53, 95% CI (0.41, 0.65), p < 0.001, and body mass index (BMI), MD = 0.53, 95% CI (0.12, 0.95), p = 0.01. Moreover, subgroup analyses were conducted according to the nutrient density with no positive results showed except for the low-density ONS on overall energy intake. Conclusions: The results of the present study indicated that ONS had beneficial effects on overall appetite, energy intake, body weight and BMI.

Effects of a Functional Ice Cream Enriched with Milk Proteins on Bone Metabolism: A Feasibility Clinical Study and In Vitro Investigation

“…These in vitro results corroborate the effects of MP-enriched ice cream on BMD and BALP in postmenopausal women. In addition, we have developed and tested an enriched food which is more patient-accepted than powder and tablet formulations [ 50 ]. In addition, ice cream also contains calcium, a constituent mineral of bone [ 51 ].…”

Effect of Oral Nutritional Supplementation on National Institute of Health Stroke Scale in Acute Ischemic Stroke

“…A study conducted by Sato et al reported that stroke patients who received higher energy intake (23.5 kcal/kg/day) during 7 days of hospitalization had higher activity daily living (ADL) at discharge and more patients discharged home than those with lower energy intake (12.4 kcal/kg/day) with p < 0.001 [15]. Research conducted by Li et al reported that oral nutritional supplementation significantly increased energy intake (p = 0.02) and increased appetite (p < 0.001), both in hospitalized patients and in the community, without reducing the amount of intake from the meal [16]. Patient compliance with the use of oral nutritional supplementation was also reported to be quite high (mean 78%) compared to other methods of nutritional support [17], [18].…”

Recommending ultra‐processed oral nutrition supplements for unintentional weight loss: Are there risks?

“…Summary recommendations from an umbrella review suggest some benefits of ONS for increasing lean mass and body weight in older adults residing in the community 34 . More recently, ONS have been shown to be effective in enhancing appetite, energy intake, and body weight, compared with a standard diet or control product, in older adults with anorexia of aging 36 . Conversely, meta‐analysis–level data evaluating the effectiveness of treatment with ONS vs usual care in malnourished older adults found no significant gains in body weight, body mass index, or other measures of nutrition status 35 .…”

“… 34 More recently, ONS have been shown to be effective in enhancing appetite, energy intake, and body weight, compared with a standard diet or control product, in older adults with anorexia of aging. 36 Conversely, meta‐analysis–level data evaluating the effectiveness of treatment with ONS vs usual care in malnourished older adults found no significant gains in body weight, body mass index, or other measures of nutrition status. 35 Alternatively, food‐based interventions for older adults supported improved energy and protein intakes but substantiation by body weight data were lacking.…”